Breech babies, ECV, Spinning Babies, C-section

At my last appointment, the midwife was unable to tell externally if my baby was head down or not. She suggested I get another sonogram done to see. I'll be going to that sono tomorrow, at 35 weeks. She said if we found out this early, it would give us enough time to figure out what to do about it.

So far, I haven't tried any kind of more "natural" techniques, chiropractics, acupuncture, or even stretches or positions, as if the baby is NOT breech, I don't want to risk him/her turning the wrong way. From what I understand, ECV is normally attempted at 37 or 38 weeks. So if baby is breech, I can try a few things before that for a week or two, and hope he/she will turn.

I really don't want a c-section, and I think I would try a version before scheduling one...despite the horror stories I've read online, studies seem to prove them safe when done in the right setting and by an experienced doctor. I'm also not sure if a vaginal birth with breech would be possible - obviously depends on the little one's position, and my hospital's policy - even though they are very accepting and even encouraging of natural childbirth methods, I have feeling that vaginal birth with breech may be too much of a liability for them.

So, has anyone else dealt with this issue? What was your timeline of finding out if baby was breech, when the baby turned, whether they turned on their own or you used any kind of methods to "help" them out, and has anyone vaginally delivered a breech baby? If not, when was your c-section performed?

When my Mom was pregnant with me she was told the same thing at 35 weeks. She went in at 37 weeks to have an external version (turn the baby around) but when they did the ultrasound I had already flipped around correctly. I had a similar experience and I've been told that most breech babies flip on their own by 36-37 weeks. I hope this is the case for you. I know that I can't have a breech birth at my hospital.

For all who don't know, breech babies are inherently high-risk for two main reasons. The first is the risk of umbilical cord compression during vaginal delivery, and the second is the risk of head entrapment.

In the vast majority of babies, the head is the largest (widest) part. The skull bones aren't fused so the head can be squooshed up a bit during delivery, but the head is usually wider than the shoulders and the fetal chest. Occasionally it isn't, which is when shoulder dystocia ensues. In a vaginal childbirth, your time and effort is spent delivering the head. Once the baby's head is out, the rest of the baby's body usually follows in 1-2 pushes. Therefore the umbilical cord (which obviously is at the level of the baby's bellybutton) is compressed for a small fraction of a second as the body slithers out, and the baby is never oxygen-deprived. If the cord is compressed, it's like a scuba diver whose air hose is pinched: no way to get oxygen, and distress very quickly ensues.

In a breech birth different parts of the baby present first. The best outcome is with a "frank breech": the baby's butt is presenting, with its legs flexed all the way up like a diver next to its head. Since the butt/hips is wide in diameter, and since the umbilical cord is protected by the fetal legs somewhat, it is safer to assume that once the body is delivered, there will be enough room for the head. Safer, but not totally safe. If the body is difficult to deliver, the cord can still be seriously compressed, and the head can become entrapped.

The worst position is a "footling breech," where the feet come out first. The baby's feet, legs and hips are narrow in diameter and are delivered quickly. The umbilical cord will be stretched up from out of the vagina, smooshed by the head which is still inside the uterus, and attached to the placenta inside. Serious cord compression and serious oxygen deprivation can result. Since the feet are so small, the baby's body can be partially delivered before the mother is even completely dilated, which means there is little to no chance of delivering the head. Even if she is completely dilated, she won't yet have done the work of labor delivering the baby's head-- that might be a couple of hours of pushing, all of which the baby is seriously oxygen-deprived. Lastly, as in any birth, tt may be the case that there is true cephalopelvic disproportion where the head simply won't fit through the pelvis, and the head is truly entrapped. This is a life-threatening emergency and even a c-section cannot save the baby as the body is already outside-- cutting into the uterus would not help. One of the only remedies is something called the Zavanelli Manuever, which is manually shoving the distressed baby back up into the uterus and then performing a c-section. This rarely works.

Vaginal breech birth had a mortality rate of nearly 3%. Footling breech birth, as a subset, has a mortality rate in some case series of 20-30%. This is a disconnect between mothers and doctors: mothers see the 3% and say "97% chance of it working? I'll take those odds!" Whereas doctors are like "3% chance of death, where the overall intrapartum death rate for all babies (even preemies, congenital anomalies, etc) is 0.6/10,000? I don't think so!" Many doctors refuse wholesale to perform vaginal breech births as they think it is an unacceptably high risk to the baby for no particularly good reason-- after all, that is a 50-fold increase in mortality.

ECVs are performed at full-term because there is a danger to them. Both the danger of it simply not working, as well as the danger of placental abruption. They are only performed under continuous fetal monitoring and the mother must be prepared to accept an emergency c-section if complications arise. And as many posters noted, position at 35-36 wks is not necessarily final position; many babies do change position before engaging in the pelvis. Once they're engaged, though, it's usually final.

I had two ECVs with my third child. This was after trying several rounds of accupuncture. Both ECVs were successful, except after the first time (performed at 37 weeks) she flipped right back around. The second ECV, I was induced immediately afterward (at 39 weeks). She was born vaginally and it was otherwise uncomplicated. As it turns out, she was all tangled up in the cord, and it was actually around her neck, but she was fine. We were very relieved.

I'm not positive about this, but I'm pretty sure it's hard to find a doctor who is enthusiastic to do ECV. My daughter felt a little bit smaller to my doctor than my previous two babies (both sons); this may have factored into why she was willing to do it. Plus, I asked her reeeeallly nicely to please try again (she had already finished her three "tries" with the second ECV and it hadn't worked, but I asked her to please try one more time, during which my daughter finally budged).

In any case, it's probably not a good idea to go into this taking for granted that someone will definitely do ECV rather than schedule you for a c-section, especially if there is anything high-risk whatsoever about your pregnancy. From talking to other moms and doctors, this is not something they will (or should) do for everybody, because it is a very risky thing to do. I was young (23), very healthy, but still very lucky that it was an option for me.

Easy for me to say, but it is not the end of the world to end up having a c-section. With my current pregnancy I am extremely skeptical that I would be offered ECV in the event of another breech-at-term baby, even if I had the same doctor. Only time will tell, and we can't possibly have control over everything that happens in birth.